改良胫骨结节远端截骨术治疗内翻型膝骨关节炎的早期疗效  

Early efficacy of modified open-wedge high tibial osteotomy below the tubercle for the correction of varus knee osteoarthritis

作　　者：赵晨 李博[1] 张兵[1] 鲍亮[1] 刘琮[1] 陈志刚 刘欣 康晋[1] ZHAO Chen;LI Bo;ZHANG Bing;BAO Liang;LIU Cong;CHEN Zhigang;LIU Xin;KANG Jin(Department of Orthopaedics,The Second Affiliated Hospital of Xi'an Medical College,Xi'an 710038,China)

机构地区：[1]西安医学院第二附属医院骨外科,西安710038

出　　处：《中华骨与关节外科杂志》2022年第3期190-195,共6页Chinese Journal of Bone and Joint Surgery

基　　金：陕西省教育厅一般专项科研计划项目(21JK0892);西安医学院第二附属医院科研项目(20KY0101)。

摘　　要：目的:观察改良胫骨结节远端截骨术治疗内翻型膝骨关节炎的安全性和早期疗效。方法:2018年5月至2020年1月采用改良胫骨结节远端截骨术治疗82例(106膝)内翻型膝骨关节炎患者。测量并对比术前与术后髋-膝-踝机械轴夹角(HKA)、胫骨内翻角(MPTA)、胫骨平台后倾角(PTS)、髌骨高度[Insall-Salvatti指数(ISI)与Blackburn-Peel指数(BPI)],观察截骨合页及骨愈合情况,应用疼痛视觉模拟量表(VAS)评分与美国西安大略与麦克马斯特大学骨关节炎指数(WOMAC)评分评估手术疗效。结果:82例患者均获得随访,随访15~38个月,平均随访(20.9±5.1)个月。术后101膝伤口愈合良好,4膝术后出现延迟愈合,1膝出现术后感染。术中6膝截骨合页部位发生断裂,随访术后106膝截骨部位均骨性愈合。术后2周HKA、MPTA均较术前增大(P<0.01),均获得矫正。术后2周髌骨高度ISI、BPI与术前比较差异均无统计学意义(P>0.05);术后2周PTS较术前减小(P<0.01)。术后12个月患者VAS评分、WOMAC均较术前改善(P<0.01)。结论:改良胫骨结节远端截骨术能够使内翻膝获得良好矫正,并避免术后髌骨低位,同时适度减小胫骨后倾角,治疗内翻型膝骨关节炎安全、有效,短期疗效好。Objective: To observe the safety and early efficacy of modified open-wedge high tibial osteotomy below the tubercle in the treatment of varus knee osteoarthritis. Methods: A total of 85 patients(106 knees) with varus knee osteoarthritis were treated with modified open-wedge high tibial osteotomy below the tubercle from May 2018 to June 2020. The hip-knee-ankle angle(HKA), medial angle of proximal tibia(MPTA), posterior tibial slope(PTS), Insall-Salvatti index(ISI), and Blackburn-Peel index(BPI) were recorded before and after treatment. Pain visual analogue scale(VAS) and osteoarthritis index score of Western Ontario and McMaster University(WOMAC) were used to evaluate the outcome of the surgery. Results: The mean duration of follow-up was(20.9±5.1) months(range, 15-38 months) in the 85 patients. The wounds of 101 knees healed well, 4 knees showed delayed healing and 1 knee showed infection. The fracture at the hinge of osteotomy occurred in 6 knees during the operation, and bony union achieved in all 106 knees. Two weeks after surgery, HKA and MPTA were significantly increases and corrected well(P<0.01), PTS was significantly decreased(P<0.01),and ISI and BPI had no significant change(P>0.05). VAS and WOMAC scores at 12 months after surgery were significantly lower than preoperative ones(P<0.01). Conclusions: Modified open-wedge high tibial osteotomy below the tubercle can obtain good correction of varus knee, avoid postoperative low patella,and moderately reduce PTS. It is a safe and effective method for varus knee osteoarthritis in the short term.

关 键 词：膝关节内翻 胫骨高位截骨术 胫骨后倾角 髌骨高度 

分 类 号：R684.3[医药卫生—骨科学]